MicroTESE in London

This describes a specialised microsurgical procedure carried out to find sperm within the testicles of men who are azoospermic (no sperm found within the ejaculate).

MicroTESE (microdissection testicular sperm extraction), is performed in men who have non-obstructive azoospermia (NOA). This is a condition where there is no sperm present in the ejaculate due to a problem with sperm production. 

NOA can be caused by various factors, such as genetic abnormalities, hormonal imbalances, or testicular injury. Often however, no cause is found.

During the microTESE procedure, Dr Sangster uses an operating microscope to examine the testicular tissue and identify areas where sperm production may be occurring. By using the operating microscope, it is easier to identify small pockets of tissue which may have normal spermatogenesis. The microsurgical approach also minimises damage to the testicle.

This minimally invasive operation is a day case procedure which is carried out under a general anaesthetic. The procedure can take up to 2 hours in duration depending on how quickly sperm is found. Dr Sangster always operates with an embryologist who has a special interest in sperm. 

A small incision in made on the midline of the scrotum, just big enough to allow access to the testicle.  The testicle is full of seminiferous tubules which contain the sperm within them. Individual tubules are removed and given to the embryologist who then carefully analyses the tissue to locate and extract individual sperm cells. Any sperm that is found can then be used for an assisted reproductive cycle (ICSI).

By being very selective on which tissue is extracted, Pippa minimises the damage to the surrounding healthy tissue. This preservation of testicular tissue is important for future testicle health. 

The wound is closed with absorbable sutures which take a month to dissolve. Men typically wake up comfortable as a local anaesthetic nerve block will be used at the end of the procedure which can last for several hours. We recommend working from home for 5 days after the procedure and no heavy lifting for 1-2 weeks depending on your job.

Compared to traditional sperm retiveal procedures, microTESE offers higher success rates and lower risk of damage to the testicular tissue.

Success rates for microTESE can vary depending on factors such as the underlying cause of azoospermia however Dr Sangster quotes a success rate of 50% in men with NOA, making it one of the most effective methods for obtaining sperm in such cases.

Overall, microTESE offers the best option for men with non-obstructive azoospermia who wish to father biological children and should be considered as part of a comprehensive fertility evaluation and treatment plan.